Provider Demographics
NPI:1699708826
Name:MANALAPAN MEDICAL PC
Entity type:Organization
Organization Name:MANALAPAN MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ITSKAHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-845-2200
Mailing Address - Street 1:345 RTE 9 S
Mailing Address - Street 2:#8
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726
Mailing Address - Country:US
Mailing Address - Phone:732-845-2200
Mailing Address - Fax:732-845-0154
Practice Address - Street 1:345 RTE 9 S
Practice Address - Street 2:#8
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726
Practice Address - Country:US
Practice Address - Phone:732-845-2200
Practice Address - Fax:732-845-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty